Reducing Bleeding Risk Associated with ACS and PCI

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Acute coronary syndrome is any type of condition causing sudden, reduced blood flow to the heart. The most common symptom of acute coronary syndrome is chest pain, which can be fatal if not immediately addressed. Fortunately, there are many effective treatments for this condition, including a variety of medications. However, these therapies increase risk for bleeding, which can increase risk of mortality both short- and long-term.

Medications used to treat acute coronary syndromes, such as aspirin and anticoagulant drugs, help improve blood flow to the heart by decreasing blood clotting, helping to prevent cardiac events. The same drugs are also used in patients undergoing percutaneous coronary interventions, to help avoid cardiovascular complications during and after the procedure. While these therapies have greatly improved outcomes for patients with acute coronary syndromes and percutaneous coronary interventions, risk for bleeding may be riskier than initially understood. After extensive research, doctors have found that patients experiencing major bleeding from acute coronary syndromes or percutaneous coronary interventions while in the hospital are at significantly higher risk for death in the following months, even if successfully treated at the time.

So how can doctors help minimize bleeding risk associated with blood-thinning treatments? First, it is important to identify those at highest risk for bleeding, which include patients that are older in age, female, have lower body weight, and/or decreased kidney function. Next, special precautions should be taken to reduce risk for bleeding, particularly in high-risk patients. This means avoiding blood transfusions if possible, which may increase risk of adverse events in patients with acute coronary syndrome, and using the lowest effective dose of medicines for the shortest amount of time. Lastly, additional research should be performed to better understand how to effectively minimize risk for bleeding in at-risk patients. Together, these steps can help improve outcomes and minimize mortality associated with bleeding.

Questions for You to Consider

How is acute coronary syndrome treated?

Acute coronary syndrome can be treated with a variety of medications and/or procedures, depending on how blocked the arteries are. Medications can include any combination of aspirin, thrombolytics, beta blockers, cholesterol-lowering drugs and ACE inhibitors, among others. Procedures can also help treat acute coronary syndrome, including angioplasty, stenting and coronary bypass surgery.

How high is risk for bleeding in patients with acute coronary syndrome?

Risk for bleeding can vary by patient characteristics. For example, women with acute coronary syndrome are 43% more likely to develop bleeding than men, and risk for bleeding increases about 30% with every 10 years of age. The type of bleeding can also vary greatly in patients, from bleeding that does not require medical attention to severe bleeding that can be fatal.